OSCE — Failure to Thrive

Brief (to candidate)

You will assess a patient with a presentation consistent with Failure to Thrive.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags. ^[1]

Clinical context

Failure to thrive (FTT) = weight consistently below the 3rd centile or crossing 2 major centile lines downward (classic criteria; z-scores now preferred — AAP 2026). Preferred term: faltering growth. Affects up to 1 in 10 children (5-10% in primary care). Classification: organic (identifiable pathology) vs non-organic/psychosocial — inadequate caloric intake, often with psychosocial contributors, is the commonest cause. Framework: inadequate intake, malabsorption (coeliac seroprevalence ~1.4%, CF), increased requirements (CHD), increased losses (GERD). Management: MDT approach (dietitian, health visitor, paediatrician), nutritional rehabilitation. ^{[1] [2] [3] [4]}

Candidate tasks

1. Clarify onset, severity, associated features, and red-flag symptoms.
2. State focused examination priorities.
3. List first-line investigations and any named score/criteria.
4. Give immediate resuscitation steps.
5. Outline definitive management with doses/routes where standard.
6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
7. Mention one special-population modifier (pregnancy, child, elderly, CKD). ^[1]

Examiner checklist

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging. ^[1]

References4ShowHide

1. [1]Goodwin ET, Buel KL, Cantrell LD. Growth Faltering and Failure to Thrive in Children. Am Fam Physician, 2023.PMID 37327159
2. [2]Kersten HB, Goday PS, Abdelhadi R, et al. Clinical Practice Guideline for Diagnosis and Management of Faltering Weight. Pediatrics, 2026.PMID 41833317
3. [3]Singh P, Arora A, Strand TA, et al. Global prevalence of celiac disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol, 2018.PMID 29551598
4. [4]Goh LH, How CH, Ng KH. Failure to thrive in babies and toddlers. Singapore Med J, 2016.PMID 27353148